Hansen Sonja, Sohr Dorit, Piening Brar, Pena Diaz Luis, Gropmann Alexander, Leistner Rasmus, Meyer Elisabeth, Gastmeier Petra, Behnke Michael
Institute of Hygiene, Charité-Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany.
J Antimicrob Chemother. 2013 Dec;68(12):2934-9. doi: 10.1093/jac/dkt292. Epub 2013 Jul 19.
Data on antibiotic usage (AU) are helpful for improvement of antibiotic stewardship. This study describes findings and targets for quality improvement in German hospitals identified in a national point prevalence survey of healthcare-associated infections and AU.
The survey was organized by the German National Reference Centre for Surveillance of Nosocomial Infections (NRZ) as part of a pan-European survey organized by the European Centre for Disease Prevention and Control (ECDC). Infection control personnel of participating hospitals were trained in methodology and performed the survey in September and October 2011. Data on the antimicrobials prescribed (e.g. compounds and indications) were analysed by the NRZ. In order to submit national data to the ECDC, a representative sample of 46 hospitals was generated, although other hospitals were invited to participate in the survey if interested.
In total, 41,539 patients were surveyed in 132 hospitals. AU prevalence in these hospitals and in the representative sample did not differ significantly [25.5% (95% CI 24.5%-26.6%) and 23.3% (95% CI 21.3%-25.5%), respectively]. AU rates were higher compared with a previous survey in 1994. Antimicrobials were administered for treatment in 70% and prophylaxis in 30% of cases. Surgical prophylaxis (SP) was prolonged (>1 day) in 70% of cases. Indication was documented in patients' charts in 73% of administrations. The most frequently used agents were cefuroxime (14.3%), ciprofloxacin (9.8%) and ceftriaxone (7.5%).
The study identified several points for improvement, e.g. the large amount of prolonged SP, the extensive use of broad-spectrum antibiotics and the high percentage of antibiotic administration without documented indication.
抗生素使用（AU）数据有助于改善抗生素管理。本研究描述了在一项全国性医疗保健相关感染和AU现患率调查中确定的德国医院质量改进的结果和目标。
该调查由德国国家医院感染监测参考中心（NRZ）组织，是欧洲疾病预防控制中心（ECDC）组织的泛欧调查的一部分。参与医院的感染控制人员接受了方法培训，并于2011年9月和10月进行了调查。NRZ分析了所开具抗菌药物的数据（如化合物和适应症）。为了向ECDC提交国家数据，生成了46家医院的代表性样本，不过其他医院如有兴趣也受邀参与调查。
总共在132家医院对41539名患者进行了调查。这些医院以及代表性样本中的AU现患率无显著差异[分别为25.5%（95%CI 24.5%-26.6%）和23.3%（95%CI 21.3%-25.5%）]。与1994年的一项先前调查相比，AU率更高。70%的病例使用抗菌药物进行治疗，30%用于预防。70%的病例手术预防（SP）时间延长（>1天）。73%的用药情况在患者病历中有记录。最常用的药物是头孢呋辛（14.3%）、环丙沙星（9.8%）和头孢曲松（7.5%）。
该研究确定了几个需要改进的方面，例如大量延长的SP、广谱抗生素的广泛使用以及无记录适应症的抗生素给药比例较高。
